Authors' objectives:

This evaluation summarizes an analysis by Miller et al. commissioned by CCOHTA. The primary purposes were:

a) To critically evaluate the clinical evidence regarding the use of methylphenidate (MPH) for attention-deficit hyperactivity disorder (ADHD) in preschoolers, school-aged children, adolescents and adults. In particular four areas of concern were addressed:

1. utilization trends within Canada

2. efficacy

3. the extent of abuse/illicit use or risk thereof

4. the appropriateness of MPH prescribing

b) To conduct a systematic review of efficacy using published studies

c) To perform an economic evaluation of the cost-effectiveness of MPH, other stimulant drugs, and non-drug treatments (psychological/behavioural) for ADHD in children.

Authors' recommendations: 1. There are clear upward trends in consumption and prescription of MPH in Canada in recent years. Data from British Columbia and Saskatchewan indicate that this upward trend is primarily related to an increase in prescribing of MPH to children. Similar trends are found in United States and Australia. 2. Abuse or misuse of stimulant drugs appears to be limited, at least in relation to other drugs. However, data specifically on MPH are lacking. 3. Evidence from a number of sources indicates indirectly that ADHD may be inadequately managed and MPH inappropriately prescribed in a proportion of cases that cannot be accurately estimated, but may range between 10 and 40 percent. 4. Sufficient evidence exists to demonstrate the efficacy of MPH in improving the behavioural problems of children and adolescent with ADHD in short term studies. The evidence of long term effectiveness of stimulant therapy is lacking. Similarly, the efficacy of stimulants in preschoolers and adults is less clearly established. 5. Meta-analysis of the clinical studies on pharmaceutical and non-pharmaceutical options for the treatment of ADHD in children and youth concluded: (a) Drug-only therapy was efficacious in ADHD and there was no difference found between MPH, dextroamphetamine sulphate (DAS) and magnesium pemoline (PEM), (b) psychological/ behavioural therapies consisting of various combinations of cognitive behavioural therapy (CBT) were not efficacious in ADHD, (c) the combination of medication and psychological/ behavioural therapies were no more efficacious than medication given alone. 6. Economic analysis suggests that when PEM was excluded from consideration or included at a lower dosage (1.4 mg/kg), MPH was dominant over other pharmaceuticals, psychological/behavioural therapy, or combined drug and psychological/behavioural therapy. When results from a trial evaluated PEM at a higher dosage (2.8 mg/kg), it became a viable option but had a cost-effectiveness ratio inferior to that of MPH. Extensive sensitivity analyses including the use of a generic brand of MPH, worst case analysis, increased or decreased physician and psychologist fees, compliance, lower (16 kg) or higher (40 kg) body weight for drug dose calculation, failed to alter these conclusions.

Authors' methods: Review

Project Status: Completed

URL for project: https://www.ccohta.ca/

Year Published: 1999

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Coordinating Office for Health Technology Assessment

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553, Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Coordinating Office for Health Technology Assessment